| NPI | 1215162417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: KS 04-53390) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: CO DR.0057606) |
| 207N00000X Dermatology (Licence: WI 21112) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MO 2026031861) | |
| 207N00000X Dermatology (Licence: WI 77791) | |
| 207ZD0900X Pathology, Dermatopathology (Licence: AL 28372) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: MN 67159) | |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2026-09-03 |